Perioperative complications of percutaneous nephrolithotomy and combined percutaneous nephrolithotomy with uni‑ and bilateral ureterorenoscopic stone therapy: results of the GRAND study

Abstract Background Percutaneous nephrolithotomy (PCNL) is a standard therapy for large renal stones. When combined with unilateral or bilateral ureterorenoscopy, stone-free rates may increase, but data on perioperative complications remain limited. Methods We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005–2023). We assessed, through multiple patient-level analyses, perioperative morbidity, mortality, length of hospital stay, intensive care unit admissions, and the evolution of PCNL during the last years in Germany. Results A total of 110,276 patients underwent PCNL ( n = 98,965; 90%) and 11,208 patients (10%) underwent PCNL + unilateral ureterorenoscopy, respectively. The number of patients undergoing PCNL + bilateral ureterorenoscopy was very low ( n = 103; 0.1%). Overall mortality was low after PCNL (0.2%) and PCNL + unilateral ureterorenoscopy (0.2%). PCNL + unilateral ureterorenoscopy was associated with increased odds of transfusion (3.3% versus 2.4%, OR: 1.3, p < 0.001), sepsis (2% versus 1.3%, OR: 1.6, p < 0.001), and acute kidney disease (2.6% versus 1.5%, OR: 1.6, p < 0.001) compared to PCNL. ICU admission rates were 1.9% after PCNL and 2.3% after PCNL + unilateral ureterorenoscopy (OR: 1.2, p = 0.004). Median length of hospital stay was 6 and 7 days, respectively. Conclusions PCNL in Germany over the past two decades was associated with low perioperative morbidity and mortality. While PCNL + unilateral ureterorenoscopy is increasingly performed and is generally safe, it carries a modestly elevated risk profile. PCNL + bilateral ureterorenoscopy, in contrast, remains rarely performed. Prospective collaborative studies are warranted to define the optimal stone management strategies.